PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
PORT AUTHORITY QUESTIONNAIRE
1.
NAME & ADDRESS: Please list the name and address of Port Authority, and enclose your
latest annual financial report and port handbook.
2.
LOCATION(S): Please list the address of your location(s), including the postal/ zip codes
where applicable, and latitudes & longitudes and attach a map showing the outline and
boundaries of the port(s).
3.
TYPE OF PORT:
Are you a landlord port? Yes  No  or an operational port? Yes  No 
If you are both a landlord and operational port, please provide the percentage split
based on revenue:- percentage of revenue as a landlord:- 
percentage of operational revenue:- 
For any Cargo Handling operations performed by you please complete the relevant
parts of the Terminal Operators /other Operations Questionnaire.
4.
FACILITIES: Please enter the number of facilities available, if none enter :Container terminals
Ro-Ro terminals
Container Depots
Warehouses
Temperature Controlled Warehouse
Breakbulk/General cargo terminals
Grain Terminals
Other (please specify):-
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Dry Bulk Terminals
Gas terminals
Oil terminals
Passenger Terminals
Dry docks
Ship repair
Yacht marina
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
5a.
SERVICES: Services provided by you, please answer "Y" performed by you, "S"
performed by your subcontractor and "N" not provided: Stevedoring;
 Dredging;
 Marine terminal operator;
 Tugs;
 Navigational information and aids;
 Salvage / ship removal;
 Marine traffic control;
 Bunkering;
 Maintained water depths;
 Dumpsites / landfill;
 Buoys and lighting;
 Waste disposal;
 Pilotage;
 Diving;
 Helicopter landing sites/airport;
 Advice to other operators;
 Warehousing;
 Security (e.g. Police);
 Temperature Controlled Warehousing  Emergency (e.g. Fire Services);
 Other (please specify);
Do you provide any other facilities / services e.g. carparks, shops, oil rig supply facilities
etc.? If yes please give details:-
5b.
SERVICES - WAREHOUSING
Only answer this part of the question if you provide warehousing or storage of any cargo
(other than containerised cargo) either as a landlord or as an operator:

What is your responsibility for the cargo stored?
 No Responsibility (if YES, please move on to Question 6)
Yes No 
 Responsibility as a landlord only for maintenance of the warehouse building, fire
prevention within the warehouse and warehouse security?
Yes No 
 Responsibility for care, custody and control of all cargo, but no responsibility for
force majeure?
Yes No 
 Responsibility for care, custody and control of all cargo, including responsibility for
force majeure?
Yes No 
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Please provide estimated maximum value of goods stored at any one time: USD
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What % of your total revenue is generated by warehousing operations?
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Do all warehouses have sprinklers and fire detection systems?
If NO, please attach details of your fire detection measures.
Yes No 
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Is there a fire main throughout the site?
Yes No 
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Is there an emergency fire pump or suitable reserve power supply to ensure there is fire
fighting water at all times?
Yes No 
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
6.
CONTRACTS/INDEMNITIES
a) Contracts with Customers (for example shipping lines):
Do you have any of the following contracts? And if so, please indicate the extent of
Liability for your negligence (please tick  the relevant box):Limited liability
iro negligence
Unlimited liability No liability
iro negligence
Other
No contracts? 
Standard contracts?
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Individual user agreements?
Port tariff/act/bylaws?;
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YN
Y N 
YN
YN
 YN
Y N 
YN
YN
YN
Y N 
YN
YN
If “Other” is ticked, please give details.
b) Other Contracts/Leases/licenses:
Do your leases / licences contain indemnities in your favour? Yes No 
Do these contracts/leases/licenses have indemnities covering your own negligence?
Yes  No 
Have you given any indemnities to an other party under any agreement?
Yes No 
If yes, please give details.
c) Tenants and/or Subcontractors:
Is there a requirement in your Contract with tenants and/or subcontractors that they
have adequate liability and property insurance?
Yes No 
If yes, what is the minimum limit that you require? USD____________________
Do you check annually that all tenants and/or subcontractors maintain and
renew their insurance?
Yes No 
Note: There is a policy requirement that your Tenants and Subcontractors purchase
and maintain adequate liability and property insurance, and that you review those policies
annually.
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
7.
VOLUMES - Please advise Cargo throughputs per Policy Year:
LAST YEAR
CURRENT YEAR
NEXT YEAR ESTIMATE
TEU’s
Break Bulk (tonnes)
Dry Bulk (tonnes)
Wet Bulk (tonnes)
Autos
Passengers
Others (specify below)
What is your annual revenue?
LAST YEAR
CURRENT YEAR
NEXT YEAR ESTIMATE
What % of revenue is derived from cargo handling?
LAST YEAR
CURRENT YEAR
NEXT YEAR ESTIMATE
How many vessel calls per annum? Please provide figures broken down into size of
vessel:LAST YEAR
CURRENT YEAR
Up to 5,000 GT
5,000 to 15,000 GT
Over 15,000 GT
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NEXT YEAR ESTIMATE
PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
8.
PROPERTY –
a) Please provide a summary of property values broken down as follows:SUM INSURED US$
Wharves, Quays and Jetties
Buildings
Warehouse/Storage Facilities
b) Please also attach a full schedule with description, values, age, location including
details of construction and details of fire extinguishing appliances / sprinklers;
c) Please itemise separately (together with the location) any single structure where the
insured value is in excess of USD 15,000,000;
d) Please itemise separately (together with location) any property outside the confines of
the port;
e) Please provide your estimated Maximum Possible Loss. USD
9.
HANDLING EQUIPMENT - Please provide the aggregate value for the current year and
next year and attach a schedule showing against each item, description, value and age.
Are your declared values based on:New replacement value?
Market value?
Depreciated (book) value?
Yes No 
Yes No 
Yes No 
Please provide your estimated Maximum Possible Loss. USD
10.
HULL and P & I - Please attach a vessel schedule with Name, Value, Type, Age, GRT,
use, and number of crew, plus horse power (for tugs).
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
11.
BUSINESS INTERRUPTION
a) What is your applicable annual revenue?
LAST YEAR
CURRENT YEAR
NEXT YEAR ESTIMATE
b) Do you require cover for increased cost of working;
Yes No 
and loss of revenue? Yes No 
c) What cover is required?
physical loss/damage of handling equipment?
physical loss/damage to property?
and port blockage of Operations?
Yes No 
Yes No 
Yes No 
d) If port blockage is required, do you require cover for:blockage of berths;
Yes No 
approach channels and locks;
Yes No 
and land entrances?
Yes No 
e) Is your electricity supply generated by yourself?
or through external means?
(please tick  the relevant box)
Do you have a back up / emergency generator?
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Yes No 
f) Are there alternative/reserve equipment/ means of access available to mitigate
any claim?
Yes No 
If yes, please give details.
Please attach a map of the port to illustrate your answer.
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
12.
LOSS PREVENTION / RISK MANAGEMENT - Please attach details of:a) Your risk control / loss control management,
b) pollution control/environmental impairment control,
c) property and equipment maintenance and staff training programmes,
d) all fire detection and fire fighting equipment and its condition, include equipment in
buildings, warehouses and on cargo handling equipment, particularly grain and coal
conveyors and other equipment, susceptible to fire/explosion;
e) Security precautions (including):
24 hour security guards?
Yes  No 
All buildings/perimeter fences/gates alarmed?
Yes  No 
Close Circuit TV?
Yes  No 
Continual documentation security checks?
Yes  No 
Other? Please attach details
Yes  No 
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f) independent surveys of facilities / equipment during the last twelve months. If you do
not have a recent satisfactory survey, it will be a subjectivity of your quote that a survey
be performed at your expense, unless otherwise agreed.
Are there any revisions to the loss prevention / risk management measures in a) to f) above
envisaged / planned during the policy period?
Yes No 
If yes, please attach details.
g) International Ship & Port Facility Security Code compliant.
Yes No 
If no, please advise status of application.
CLAIMS HISTORY - Please attach separate Liabilities, Physical Damage and Hull claims
histories (both paid and outstanding and any related fees or expenses including legal fees) for the
last 5 complete years net of any deductible and advise of any deductible applicable. Please also
attach details of any existing litigation.
Signed
Date
Company Position
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PORT AUTHORITY QUESTIONNAIRE – JANUARY 2004
IMPORTANT:
This questionnaire is to be completed and signed by the Assured and will form part of the Insurance
Policy.
The premium charged and the conditions of this Policy are based upon the information provided in
this questionnaire, any operations and/or physical changes in the nature of the Assured's Operations
during the policy period which materially changes or alters in any way the information contained in
this questionnaire must immediately be advised to Underwriters. Any change advised will be
assessed by Underwriters to enable them to decide whether they are prepared to continue to provide
coverage and at what terms. Failure to comply with this requirement could affect the validity of the
Policy.
ASSURED TO NOTE:
The construction of this policy shall be governed by English law and practice. Any dispute
between Underwriters and the Assured as to the meaning of this Policy shall be resolved by
Arbitration in London strictly in accordance with the terms of the Arbitration clause
contained in the policy.
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